Pathways from Sexual Stigma to Mpox Preventive Intentions: A Mediation Analysis Guided by the Reasoned Action Approach

This study examined how three dimensions of sexual stigma (enacted, felt, and internalized) were related to mpox preventive intentions among gay and bisexual men (GBM) through mediating pathways outlined by the Reasoned Action Approach (RAA). Data were collected from 439 GBM via an online survey during the peak of the 2022 mpox outbreak in the U.S. Path analysis examined associations among sexual stigma dimensions and mpox preventive intentions mediated through RAA behavioral predictors, including instrumental attitude, experiential attitude, injunctive norm, descriptive norm, capacity, and autonomy. Results showed that enacted stigma was not associated with any RAA predictors or mpox preventive intentions. Felt and internalized stigma were positively related to all RAA predictors, but neither of them was associated with intentions. Except for experiential attitude and injunctive norm, all other RAA predictors were positively related to intentions. Indirect effect analysis showed that felt and internalized stigma positively predicted intentions (R² = 0.74) through instrumental attitude, descriptive norm, capacity, and autonomy regarding mpox prevention. The findings demonstrate that different dimensions of sexual stigma predicted mpox preventive intentions through distinct cognitive pathways. Prevention interventions should leverage these pathways to encourage protective intentions while working to reduce the harmful impacts of stigma.